HomeMy WebLinkAboutCLE200800021 Legacy Document 2013-01-03i
Application for
Zoning Clearance Building Permit
#B2007- 01964AC
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126
511106 Page 2 of 3
218
OFFICE USE ONLY�UO� /
CLE #
Zoning Clearance = $35
Check # a, S Date: - 25-0
PLEASE REVIEW ALL 3 SHEETS
Receipt # Staff:
PARCEL INFORMATION [ q ,,
Tax Map and Parcel: 03200- 00- 00 -006AO Existing Zoning PDIP
Parcel Owner: University of Virginia Foundation
Parcel Address: 1001 Research Park ' Blvd. city Charlottesville state VA zip 22911
(include suite or floor) U 1 e 11
PRIMARY CONTACT
Who should we call /write concerning this project? Michael Stumbaugh
Address: P.O. Box 400218 city CharlottesvilleState VA -Zip 22904
Office Phone: &L4)982 -3777 Cell #531 -1938 Fax# 982 -4852 E-mailstum@virginia.edu
APPLICANT INFORMATION S stems Corporation
Business Name /Type: y p
Previous Business on this site none
Describe the proposed business, including use, number of employees, number of shifts, available parking spaces and any
additional information that you can provide:
ice Space
*This Clearance will only be valid on the parcel for which it is approved. If you change, intensify or move the use to a new location, a new Zoning
Clearance will be required.
I hereby certify that I own or have the owner's permission to use the space indicated on this application. I also certify that the information provided
is true and accurate to the best of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature Printed
APPROVAL INFORMATION
f/J Approved as proposed [ ] Approved with conditions [ ] Denied
[ ] Backflow prevention device and /or current test data needed for this site. Contact ACSA, 977 -4511, x119.
[ ] No physical site inspection has been done for this clearance. Therefore, it is not a determination of compliance with the existing
site plan.
[ ] This site complies with the site plan as of this date.
Notes:
Building Official Date 1
w
Zoning Official Date 19"i)25
Other Official Date
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126
511106 Page 2 of 3
218
Intake to complete the following:
YES ❑ NO
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
❑ YES [2/NO
Will there be food preparation?
If so, give applicant a Health Department form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
❑ YES E9/NO
Is parcel on private well or public water?
If private well, provide Health Department form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
BYES ❑ NO
Is parcel on septic or public sewer?
❑ YES ❑ NO
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
RYES ❑ NO
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit # Ci
Zoning Tech to complete the following:
Violations:
❑ YES ❑i NO
If so, List:
Variance:
❑ YES 4 NO
If so, List:
Reviewer to complete the following:
Squar ootage of Use: 23 5A
/ YES ❑ NO
Permitted as:
Under Section: �cc,
Supplement dry, regulations section:
�a
Parking fo(rnula: 0 A-pa
Required spaces:
❑ YES [] NO
Items to be verified in the field:
Inspector
Notes:
SP/
[E YES ❑ NO
p'� 2 e.
Date:
5/1/06 Page 3 of 3